Diagnostic dilemma faced in distinguishing primary thyroid lymphoma from Hashimoto’s thyroiditis - A case series on rare cause of progressive respiratory distress

Authors: TRUPTI JANSARI, JAY JANSARI, VISHWA GEVARIYA, AMIT CHAUHAN, jigna patel

DOI: 10.18231/j.ijirm.12597.1928031045

Keywords: Primary thyroid lymphoma, Midline neck swelling, Respiratory distress, Immunohistochemistry.

Abstract: Primary thyroid lymphomas (PTL) are extremely uncommon and constitutes less than 2% of all thyroid malignancies. PTL is defined as a lymphoma that affects just the thyroid or the thyroid along with regional lymph nodes, with no metastasis to other sites at the time of diagnosis. Here we represent four cases of the patients presented with midline neck swelling. All the patient had complains related to pressure symptoms like dysphagia, change in voice and dyspnea. The swelling moved with deglutition and did not move with protrusion of the tongue. Sonographies performed in two cases were suggestive of thyroiditis and in other two cases were suggestive of goiter. Cytology was performed only in two cases which were suggestive of hashimoto’s thyroiditis. Patients underwent total or hemi - thyroidectomy surgery as needed and the specimens were received in histopathology department. The representative sections were taken and stained with hematoxylin and eosin stain. It was difficult to distinguish on microscopy between Hashimoto’s thyroiditis and lymphoma. Immunohistochemistry panel consisting of CD – 45, TTF – 1, CD -19, CD – 20, CD – 10, Cyclin – D1 and Ki – 67 were kept. The atypical lymphoid cells stained with CD – 45, CD – 19 and CD – 20 and atrophied thyroid follicles stained positive for TTF-1. The final diagnosis of diffuse large B cell lymphoma with non germinal center B-cell subtype was given. For treatment, R – CHOP regimen (Rituximab, Cyclophosphamide, Adriamycin, Vincristine, Prednisolone) with chemotherapy and radiotherapy was given after assessing the type of treatment needed.